Complex health concerns among child welfare populations and the benefit of pediatric medical homes

Children referred to child welfare have higher-than-average rates of physical, mental, and developmental health conditions, yet coordinating medical care to address their complex needs is challenging. This study investigates complex health characteristics of child welfare involved children to inform evolving patient-centered medical homes that incorporate multidisciplinary care and social health determinants. Study questions include: (1) To what degree do child welfare-involved children present with complex physical, behavioral, and developmental conditions? (2) How does the clustering of complex health concerns vary according to developmental stage? (3) What demographic factors relate to complex health concerns? Data are from 5873 children (birth to 18) who participated in the National Survey of Child and Adolescent Well-being II. Latent class analyses were conducted for children in four developmental groups (infants, preschool-age, elementary school-age, and adolescents), including up to 11 indicators from standardized health measures. For all developmental groups, the best fitting model indicated a complex health concern class and a class with fewer health concerns. Multivariate logistic regressions revealed that membership in the complex health concerns class was associated with: increased age, poverty, poor caregiver health, out-of-home placement, gender, and race/ethnicity; although some developmental differences in predictors were observed. Results suggest that for younger children, preventive approaches and integration of developmental specialists in primary care is needed, while school-age children and adolescents demonstrate greater need for integrated behavioral health. All developmental groups would benefit from multidisciplinary teams that address complex health issues related to environmental risks common among children involved in child welfare. (C) 2017 Elsevier Ltd. All rights reserved.